What are the responsibilities and job description for the Coding Auditor position at ClaimDOC?
ClaimDOC is hiring a Coding Auditor, which is a full-time hybrid position (2-3 days in office). ClaimDOC is a national medical claim auditing and member advocacy company driven to deliver a successful and sustainable health plan for employers and their employees. We are a rapidly growing company based in West Des Moines, Iowa, and we are seeking individuals who are innovative and motivated to join our team and mission.
Job Summary
The Coding Auditor will be responsible for reviewing, auditing and repricing medical facility and professional claims for accuracy and compliance with industry laws and contractual language on behalf of clients. Candidates must possess a strong understanding of Medicare pricing methodology as described below. The ideal candidate must display a high degree of independent judgment and professional discernment that enhances the work performed in order to achieve success in this position.
Please note: This position is hybrid — typically 2-3 days in the West Des Moines office and the other days working remotely.
Essential Duties and Responsibilities
Ability to understand logic of standard medical coding (i.e., CPT, ICD-10, HCPCS, etc.).
Responsible for adjudicating claims to maintain/comply with client contracts and plan documentation.
Determine accurate payment criteria for clearing pending claims based on defined policies and procedures.
Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
Maintain quality standards and aging timeframes.
Contribute positively as a team player.
Comply with all departmental and company policies and procedures.
Research unclear and unusual claims.
Complete other tasks as assigned.
Qualifications
Current AAPC or AHIMA coding certification required or actively working toward certification.
5 years’ experience, preferred, in an auditing, billing or coding role that requires vast knowledge of medical coding and/or Medicare pricing methodology in the inpatient, outpatient or provider setting.
Knowledge of health insurance, HMO and managed care principles, including provider reimbursement methodologies, such as case rates, global rates, per diems, percentage discounts, usual and customary fee schedules, RVU- and RBRVS-based fee schedules, and health plan-specific schedules.
Experience in health plan operations and an understanding of insurance claims processing desired.
Insurance claims or managed care environment preferred.
Ability to work independently and in a team environment.
Integrity and discretion to maintain confidentiality of members, employee and physician data.
Excellent interpersonal, oral and written communication skills.
Strong attention to detail and organization.
Strong analytic skills.
Flexibility and ability to multitask in a fast-paced environment.
Strong computer skills.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. ClaimDOC Is a drug- and tobacco-free workplace.
ClaimDOC offers competitive pay and rich benefits, including medical, dental, vision and life insurance, and sponsors a 401(k) and FSA. The candidate will also earn paid time off and paid holidays as a full-time employee.
Job Summary
The Coding Auditor will be responsible for reviewing, auditing and repricing medical facility and professional claims for accuracy and compliance with industry laws and contractual language on behalf of clients. Candidates must possess a strong understanding of Medicare pricing methodology as described below. The ideal candidate must display a high degree of independent judgment and professional discernment that enhances the work performed in order to achieve success in this position.
Please note: This position is hybrid — typically 2-3 days in the West Des Moines office and the other days working remotely.
Essential Duties and Responsibilities
Ability to understand logic of standard medical coding (i.e., CPT, ICD-10, HCPCS, etc.).
Responsible for adjudicating claims to maintain/comply with client contracts and plan documentation.
Determine accurate payment criteria for clearing pending claims based on defined policies and procedures.
Identify claim(s) with inaccurate data or claims that require review by appropriate team members.
Maintain quality standards and aging timeframes.
Contribute positively as a team player.
Comply with all departmental and company policies and procedures.
Research unclear and unusual claims.
Complete other tasks as assigned.
Qualifications
Current AAPC or AHIMA coding certification required or actively working toward certification.
5 years’ experience, preferred, in an auditing, billing or coding role that requires vast knowledge of medical coding and/or Medicare pricing methodology in the inpatient, outpatient or provider setting.
Knowledge of health insurance, HMO and managed care principles, including provider reimbursement methodologies, such as case rates, global rates, per diems, percentage discounts, usual and customary fee schedules, RVU- and RBRVS-based fee schedules, and health plan-specific schedules.
Experience in health plan operations and an understanding of insurance claims processing desired.
Insurance claims or managed care environment preferred.
Ability to work independently and in a team environment.
Integrity and discretion to maintain confidentiality of members, employee and physician data.
Excellent interpersonal, oral and written communication skills.
Strong attention to detail and organization.
Strong analytic skills.
Flexibility and ability to multitask in a fast-paced environment.
Strong computer skills.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. ClaimDOC Is a drug- and tobacco-free workplace.
ClaimDOC offers competitive pay and rich benefits, including medical, dental, vision and life insurance, and sponsors a 401(k) and FSA. The candidate will also earn paid time off and paid holidays as a full-time employee.
Benefits:
Health Insurance, Vacation & Paid Time Off